CYTOKINE STORM and the INFLUENZA PANDEMIC: The United States Response

On August 13, 2005 it was reported that the United States ordered $130 million of Tamiflu

The United States, United Kingdom, France, Finland, Norway, Switzerland, New Zealand and major corporations are stockpiling two anti viral medications with the potential to thwart a bird flu pandemic according to newsday.com. However, Gary Kalkut, MD, an infectious disease specialist and Director of Medicine at Montefiore Medical Center in the Bronx, stated that vaccination and not anti-virals may be the most effective course to prevent such a pandemic. He stated that this is because antivirals such as Tamiflu and Relenza have to be started early enough, usually within the first two days of infection to be effective. If these drugs are not on hand and easily accessible within a few days of symptoms, they will be significantly less effective against the infection.

Reports of avian influenza (or the bird flu) have primarily come from Asia in the last two years, but cases have been increasing, and although most cases appear to be from direct contact with infected birds, some cases may have involved human-to-human transmission. Avian influenza carries a 55% mortality rate (62 deaths among 112 infected people). This is much higher than the estimated mortality rate (approximately 2.5%) of the great influenza pandemic of 1918 to 1919 that was responsible for between 50 million and 100 million deaths world-wide.

Infectious disease experts say that if the virus acquires the genes necessary for person-to-person transmission, then the threat of a world-wide pandemic would be imminent. Based on a mortality rate that is 22 times greater than the 1918 pandemic, and in a era of rapid transportation by air, this virus would have significantly greater lethal potental if it were able to successfully make the genetic jump to human-to-human transmission.

Notable recent developments regarding antiviral purchases:

Kevin Morris, vice president of marketing at Philadelphia-based International SOS, a company which provides medical services for fortune 100 corporations, is advising its clients with employees living abroad to stockpile "antiviral drugs" in case of a pandemic.Morris stated that the companies are not being advised to stockpile a specific drug. The World Health Organization, however, has reported that only Tamiflu and Relenza are believed capable of thwarting H5N1, the virus responsible for the avian flu.

According to health officials, orders for Tamiflu rival the run on the antibiotic Cipro (ciprofloxacin) four years ago in the wake of the post 9/11 anthrax scare.

Roche Pharmaceuticals, the manufacturer of Tamiflu, is receiving orders --large enough to cover 20%-40% of their populations-- from governments of 25 countries world-wide, as well as from major corporations.

The U.S. government recently purchased more than $130 million of Tamiflu for the nation's emergency pharmaceutical stockpile. This expenditure probably is only enough to treat about 25% of the US population.

According to Nancy Pekarek, a spokesperson for GlaxoSmithKline, the manufacturer of Relenza, the company has received orders for 1.7 million doses from the German Government.